Flexible Spending Account


Provided by Diversified Administration, Inc.

The Section 125 Flexible Benefits plan allows you to pay for some of your expenses before federal income tax and Social Security are taken from your check.

Expenses that you may pretax include:

 - Medical, dental and vision insurance cost shares
 - Employment related dependent daycare expenses (Up to $5,000 per plan year)
 - Certain unreimbursed medical expenses (Up to $2,600 per plan year)

Plan year:  September 1, 2018 through August 31, 2019.

Eligibility: All full time employees and salaried part time employees who have successfully completed the 60 day probationary period may participate on the first of the month following 60 days of continuous employment.


Below are resources provided by Diversified Administration for your convenience.

FORMS: http://www.div125.com/?page_id=24

This page has all of the forms you may need. Here you can find the newly revised claim form, Direct Deposit forms, a list of permitted expenses, and much more. You can also find the FSA Ready Receipt form, for instances when your service provider is unable to provide you with a receipt or documentation, which are required for reimbursement. Simply print out that form, have the service provider complete it, and then submit that to Diversified Administration along with a completed claim form, and that will be used to process your claim.

FAQ: http://www.div125.com/?page_id=18

The FAQ page answers many questions you may have about your benefit, including how the plan works, what expenses are allowable, how long you have to wait to get paid, and many more.

*Please refer to your Summary Plan Description (available from Human Resources) for a complete description of the FSA services and contract information.